Medicare e-visits could change the game

So, it seems Medicare is preparing to pay for e-visits by consulting specialists for hospitals. By itself, this might not change hospital IT much--after all, there probably won't be a high volume of such consults at first--but that doesn't mean it's not significant. In fact, I think this could prove to be a real game-changer for the industry.

As most of you probably know, one of the big forces holding back progress in telemedicine and web-based consults has been that health plans wouldn't pay for them. It seems most of the insurance industry isn't convinced that remotely-delivered care is valuable enough to pay for, despite a great deal of evidence that remote monitoring, in particular, can have a tremendous impact on a patient's well-being.

In the mean time, some hospitals have shouldered the costs of setting up telemedical connections to specialists in say, neurology--and others have farmed out critical care monitoring to eICUs staffed by remote intensivists. Also, a small number of physicians have been getting compensated for e-visits through the limited number of health plans that reimburse for such services. But these are pioneers. For most of the industry, web-based care or telemedicine is mostly a nice-to-have idea which might be practical someday.

If Medicare begins paying for e-visits of any kind, however, things could change abruptly. As we all know, when Medicare acts, everyone else follows...just a law of the jungle, I guess. I imagine e-visits will follow this pattern too.

That being said, I'd argue that most providers are ill-prepared to support e-visits. There are countless questions to answer. What back-end technology will you use to capture and store data from the visits? How will the visits be presented to patients? What kind of interface will be best for doctors to use in delivering care? Will the e-visits be text-based or will you use video, and if so, will it be IP video? If you use IP video, how will you handle bandwidth demands? And so on.

Given that Medicare is poised to approve e-visits, I'd argue that it's high time to make some real-world plans for e-visit infrastructure. If and when you do, I'd love to hear how it's going for you! Write to me at anytime. - Anne

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